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Friday, November 9, 2012

Dinosaurs Still Roaming: Trying to get medical info from another doctor

Remember that case I mentioned earlier this week, where I was trying to coordinate with PCP, neurologist, home health RN, in-home paid caregivers, and the assisted living facility?

Well, I had left out the orthopedic surgeon. He operated on the patient several weeks ago, but I have yet to meet an orthopedic surgeon who is interested in the geriatrician's recommendations, once the patient is out of the hospital. Besides, seemed to me that the surgeon wouldn't need to do anything differently based on my findings.

However, I had been hoping to get the hospital discharge summary, to get more data and some details on the patient's status at that time.

And here's what has happened so far:

I faxed him a note and a release of information signed by the patient's representative, asking for some specific information (imaging studies, initial consult note, discharge summary for recent hospitalization).

Several days later, I get a letter, in the mail, with a copy of my fax, and a note from this ortho practice, informing me that "Effective 10/1/03, any Medical Records Requests regarding the practice's patients must be addressed and served to :

[Name of Hospital Which Apparently Owns or Is Affiliated With Practice] , Health Information Department, Attn: Release of Information, [Address], San Francisco. Fax # is 415-xxx-xxxx, or to check status, please call 415-xxx-xxxx.

That's right, folks. I faxed a request for medical information so I could more effectively provide my geriatric consultative care, and I am sent in response a SNAIL MAIL letter, telling me who to mail or fax.

The said snail mail letter was hand-addressed. I am of course wondering why the heck they couldn't have faxed me back their redirective notice. At least then I could've been sitting here irritated a few days sooner, wondering why they aren't doing me the courtesy of forwarding my request directly to their Health Information Department.

You see now why primary care offices must keep squads of office staff on hand to manage communication? And why it's invariably easier to order a duplicate imaging study, than to try to wrest the results from another clinician's office?

My initial reaction was that 24 hours is too long. (Have found myself far too often missing the needed info at the time the patient was sitting in the office with me; that's when you need to access that discharge summary now, not in 24 hours.)

Now, as I look at this snail mail letter, I can see why 24 hour turnaround might sound pretty good to many outpatient clinicians.

I, of course, want nearly immediate access. This would allow me to do today's work today. For the patient and family, these means I can do my medical decision-making on their behalf right when they ask me to, instead of saying that I'll get back to the them (and then we all have to keep track of that unfinished task).

Which existing or promised technologies would enable me to easily access the information this doctor has?

In this case, the gatekeeper for the information is not the physician himself, or his personal office staff. He has delegated (or outsourced) it to the hospital system with which he's affiliated.

How about a health information exchange? I know about these in theory but haven't tried in practice. Just took a look on Google. Apparently we have our own grassroots local HIE in the works: HealthShare Bay Area. Which seems to have been in the works for a few years already. Of course the FAQs provide no information as to when the information might be available, and how a small independent practitioner such as myself would sign up (is this just for the big hospitals to talk to each other? is a small grassroots non-profit really up to this task?)

How about...something where the patient gets to always access his medical information, and can share it with whatever doc he chooses? Not available now, but perhaps in the future?

When will we leave the healthcare communication dinosaurs behind?

Can anyone else recommend a solution that might be actually operable here in SF, say, within 3 years?